Prevailing income-based disparities in cardiovascular events in young hospitalized adults with cannabis use disorder: insights from a population-based analysis

Cannabis use and low socioeconomic status are recognized as distinct risk factors for cardiovascular pathologies. This retrospective cross-sectional study aims to investigate the association between income status and cardiovascular disease risk among young hospitalized adults with recreational cannabis use or cannabis use disorder (CUD). We analyzed young adult hospitalizations (18–44 years) with known CUD from the 2020 National Inpatient Sample. Propensity score-matched analysis (1:1) was used to compare comorbidities and major adverse cardiac and cerebrovascular events (MACCE) between the high-income quartile (HIQ) and low-income quartile (LIQ) within the CUD cohort. Out of the young adult admissions, a total of 286,855 individuals were identified as recreational cannabis users. After propensity matching, we divided the CUD cohort into 63,355 patients with HIQ (41.1% female) and LIQ (41.4% female). While both cohorts exhibited comparable ages and racial distribution (> 65% white), the individuals from the LIQ cohort were predominantly from the South (45.7% vs. 27.9%), visiting rural hospitals (13.9% vs. 1.3%), with Medicaid (56.3% vs. 41.1%) as the predominant payer. Additionally, the LIQ cohort had a higher prevalence of drug abuse (65.5% vs. 58.4%), tobacco use (24.9% vs. 22.6%), HTN (17% vs. 14.7%), chronic pulmonary disease (13.2% vs. 12.7%), DM (8% vs. 6.6%), and obesity (10.9% vs. 10.0%). Additionally, in-hospital outcomes like MACCE (2% vs. 0.8%) and acute ischemic stroke (AIS) (0.5% vs. 0.3%) were higher in the LIQ cohort (Graphical Abstract). After adjusting for confounding factors, the risk of AIS in the HIQ cohort was 37% lower than in the LIQ cohort (OR: 0.63 [95% CI: 0.42–0.96]). All p values < 0.05. Higher prevalence of CVD risk factors in the LIQ-CUD group and lower odds of AIS-related admissions in the HIQ-CUD group warrant targeted interventions and policy measures to understand and address the behavioral risk of cannabis use by economic status and disparities in MACCE.